When Hydronephrosis Was Not Physiological: A Case of Septic Shock Secondary to Obstructive Uropathy in Pregnancy
- 1Obstetrics and Gynaecology, Aneurin Bevan University Health Board, Newport, GBR
Abstract
Urosepsis in pregnancy is a life-threatening condition requiring early recognition, rapid multidisciplinary escalation and timely source control. Physiological hydronephrosis is common during pregnancy and may obscure clinically significant urinary tract obstruction. We report a 26-year-old gravida 5 para 3 woman at 30 weeks’ gestation who presented with severe right-sided loin pain. Initial ultrasound demonstrated moderate right hydronephrosis without a visible calculus. Within hours, she deteriorated with pyrexia, acute kidney injury, lactic acidosis and septic shock. Computed tomography demonstrated high-grade obstruction of the right renal collecting system secondary to a ureteropelvic junction calculus with associated inflammatory change. Following maternal deterioration and evidence of foetal compromise, an urgent multidisciplinary decision was made to proceed with category 1 caesarean delivery followed by cystoscopy and right ureteric stent insertion. Cultures grew Klebsiella pneumoniae. The patient subsequently required intensive care support including invasive ventilation, vasopressors, renal replacement therapy and treatment for disseminated intravascular coagulation. Both maternal and neonatal outcomes were favourable. This case highlights the diagnostic challenge of distinguishing physiological hydronephrosis from pathological obstruction in pregnancy and emphasises the importance of source control in infected obstructive uropathy.
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BibTeX
@article{chowdhury2026when,
title = {{When Hydronephrosis Was Not Physiological: A Case of Septic Shock Secondary to Obstructive Uropathy in Pregnancy}},
author = {Soneya Chowdhury and Wisdom A Amoo and Sumi Surendran and Lisa Pilkington},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.118251},
url = {https://europepmc.org/article/PMC/PMC13722354},
note = {CC BY},
}
RIS
TY - JOUR
TI - When Hydronephrosis Was Not Physiological: A Case of Septic Shock Secondary to Obstructive Uropathy in Pregnancy
AU - Soneya Chowdhury
AU - Wisdom A Amoo
AU - Sumi Surendran
AU - Lisa Pilkington
PY - 2026
DA - 2026/10/20
JO - Cureus
DO - 10.7759/cureus.118251
UR - https://europepmc.org/article/PMC/PMC13722354
AB - Urosepsis in pregnancy is a life-threatening condition requiring early recognition, rapid multidisciplinary escalation and timely source control. Physiological hydronephrosis is common during pregnancy and may obscure clinically significant urinary tract obstruction. We report a 26-year-old gravida 5 para 3 woman at 30 weeks’ gestation who presented with severe right-sided loin pain. Initial ultrasound demonstrated moderate right hydronephrosis without a visible calculus. Within hours, she deteriorated with pyrexia, acute kidney injury, lactic acidosis and septic shock. Computed tomography demonstrated high-grade obstruction of the right renal collecting system secondary to a ureteropelvic junction calculus with associated inflammatory change. Following maternal deterioration and evidence of foetal compromise, an urgent multidisciplinary decision was made to proceed with category 1 caesarean delivery followed by cystoscopy and right ureteric stent insertion. Cultures grew Klebsiella pneumoniae. The patient subsequently required intensive care support including invasive ventilation, vasopressors, renal replacement therapy and treatment for disseminated intravascular coagulation. Both maternal and neonatal outcomes were favourable. This case highlights the diagnostic challenge of distinguishing physiological hydronephrosis from pathological obstruction in pregnancy and emphasises the importance of source control in infected obstructive uropathy.
SN - 2168-8184
ER -